Background

Delayed cerebral ischemia (DCI) contributes to poor outcome after subarachnoid hemorrhage (SAH). The pathophysiology of DCI is not fully understood, which hinders adoption of a uniform definition. Furthermore, a reliable diagnostic test and an effective evidence-based treatment are lacking. This may lead to variations in care.

Methods

A web-based survey on variations in the definition, diagnosis and treatment of DCI was designed and sent to intensivists, neurologists and neurosurgeons of all nine hospitals in the Netherlands who take care of SAH patients. Responders were categorized into physicians responsible for coordination of SAH-care and those not. For questions on definition and diagnosis only responses of coordinating physicians were evaluated. For treatment questions all responses were evaluated.

Results

The response rate was 34% (106/314). All nine hospitals were represented. Twenty-seven responses did not provide answers on definition, diagnosis or treatment questions and therefore 79 responses were used for analyses. Signs of vasospasm are required by 21 (44%) of 47 coordinating physicians when considering DCI. Twenty-four (51%) of 47 coordinating physicians do not use a diagnostic test for a positive diagnosis of DCI. When discharged within 21 days, 33 (45%) of 73 responders do not provide the patient with a prescription for nimodipine continuation. Finally, all but one hospital treat DCI with hypertension induction.

Conclusions

We found large variations in the definition, diagnosis and treatment of DCI in the Netherlands. In the absence of evidence-based treatments, standardization of management seems warranted in an effort to optimize DCI-care.